ACOG Releases Updated Guidance on Exercise in Pregnancy and Postpartum, Includes Recommendations for Athletes

Washington, D.C. —The American College of Obstetricians and Gynecologists released updated guidance on exercise in pregnancy today that includes a new section on pregnant athletes. 

Committee Opinion 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period reflects current literature that exercise is beneficial for most women during pregnancy and postpartum for myriad reasons.

“It’s always best for women, especially athletes and those with specific health conditions, to consult with their physician or clinicians and undergo clinical evaluation before undertaking any exercise program,” said Meredith L. Birsner, MD, a lead author of the committee opinion. “Generally, we want to encourage women who already engage in exercise to continue to engage in some form of physical activity that is appropriate for them as an essential component of a healthy lifestyle and pregnancy.” 

The guidance states that competitive athletes should pay attention to avoiding hyperthermia and blunt trauma, maintaining proper hydration, and sustaining adequate caloric intake to prevent weight loss. Due to the fact they might have a strenuous training schedule and desire to resume high-intensity training postpartum sooner than other women, it’s also important for athletes to be under close supervision of their doctor. 

In the case of an elite athlete—defined as someone with several years of experience in a sport who has competed with other high-level performers and trains year-round at a high level—resistance training can be an area of concern. 

The guidance also includes an expanded section on the benefits of exercise for all women that includes new literature that finds exercise may reduce risk of gestational diabetes, preeclampsia, and cesarean birth and can also be a factor in preventing depressive disorders in the postpartum period.

“Overall, the evidence suggests that aerobic and strength conditioning exercises should be encouraged before, during, and after pregnancy,” said Birsner.

Committee Opinion 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period replaces Committee Opinion 650 and is published in the April edition of Obstetrics & Gynecology.

Other recommendations issued in the April edition of Obstetrics & Gynecology: 

Committee Opinion 801: Assessing and Adopting New Medical Devices for Obstetric and Gynecologic Care
The purpose of this document is 1) to help obstetrician–gynecologists better understand the U.S. Food and Drug Administration’s regulatory process for the marketing of medical devices; 2) to educate obstetrician–gynecologists on the importance of understanding available evidence on the safety, efficacy, and indications for devices in clinical practice; 3) to encourage obstetrician–gynecologists to report safety events associated with medical devices; and 4) to provide guidance on what to consider when adopting new medical devices. The decision to incorporate new technology in a patient’s care may be complex. Some medical devices are marketed for gynecologic conditions but may have unclear indications for use or unclear safety and efficacy profiles, or both. Patients often have questions about treatments and procedures involving devices, especially if a device has received media attention; therefore, a basic understanding of how devices are regulated and what type of data are or are not required before a device is brought to market is important for patient care. When adopting a new medical device, obstetrician–gynecologists should achieve proper training and should understand the evidence on safety and effectiveness and the indications for the device’s use. Obstetrician−gynecologists and other health care providers should be aware of the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience database and, ideally, should become familiar with the adverse event report form and report serious adverse events that may be associated with a medical device, use errors, product quality issues, and therapeutic failures.

Committee Opinion 802: Management of Women with Phenylalanine Hydroxylase Deficiency (Phenylketonuria)
Phenylalanine hydroxylase (PAH) deficiency is an autosomal recessive disorder of phenylalanine metabolism that is characterized by insufficient activity of PAH, a hepatic enzyme. Throughout this document, phenylalanine hydroxylase [PAH] deficiency is used instead of older nomenclature of phenylketonuria, in order to reflect the spectrum of PAH deficiency and in accordance with the terminology established by the American College of Medical Genetics and Genomics. Aspects of PAH deficiency management that are particularly relevant to obstetrician–gynecologists or other obstetric care providers include the prevention of embryopathy associated with maternal hyperphenylalaninemia and PAH deficiency and the risk of genetic transmission of PAH deficiency. Family planning and prepregnancy counseling are recommended for all reproductive-aged women with PAH deficiency. The fetal brain and heart are particularly vulnerable to high maternal concentrations of phenylalanine. The crucial role played by maternal dietary restriction before and during pregnancy should be stressed in counseling patients with PAH deficiency; the goal should be to normalize blood phenylalanine levels (less than 6 mg/dL) for at least 3 months before becoming pregnant and to maintain at 2–6 mg/dL during pregnancy, in order to optimize developmental outcomes for the fetus. Although phenylalanine levels are increased in the breast milk of patients with PAH deficiency, breastfed infants who do not have PAH deficiency have normal enzyme levels and no dietary restriction. Breastfeeding is safe for infants born to women who have PAH deficiency provided the infants do not have PAH deficiency. Coordinated medical and nutritional care, as well as follow-up with the patient’s metabolic geneticist or specialist, are important in the postpartum period. Because newborns with PAH deficiency appear normal at birth and early detection can improve developmental outcomes for children, newborn screening for PAH deficiency is mandated in all states. This Committee Opinion has been revised to include updates on advances in the understanding and management of women with PAH deficiency and recommendations on prepregnancy counseling, serial fetal growth assessments, and fetal echocardiography.

Committee Opinion 803: Confidentiality in Adolescent Health Care
Confidential care for adolescents is important because it encourages access to care and increases discussions about sensitive topics and behaviors that may substantially affect their health and well-being. Obstetrician–gynecologists and other health care providers who care for minors should be aware of federal and state laws that affect confidentiality. There should be private conversation time between the health care provider and adolescent patient. Generally, parents or guardians and adolescents should be informed, both separately and together, that the information each of them shares with the health care provider will be treated as confidential. Additionally, they should be informed of any restrictions to the confidential nature of the relationship. Obstetrician–gynecologists and other health care providers and institutions that establish an electronic health record (EHR) system should consider systems with adolescent-specific modules that can be customized to accommodate the confidentiality needs related to minor adolescents and comply with the requirements of state and federal laws. If the EHR system does not allow for procedures to maintain adolescent confidentiality, the obstetrician–gynecologist or staff should inform the patient that parents or guardians will have access to the records, and the patient should be given the option of referral to a health care provider who is required to provide confidential care. Obstetrician–gynecologists are encouraged to know their individual systems and institutional policies regarding confidentiality, EHRs, patient portals, and the open access for visit notes. This document has been updated to include information on patient portals, guidance on the release of medical records, examples of ways to safeguard adolescent patients’ confidentiality, and talking points to use with parents and guardians.

Committee Opinion 805: Legal Considerations in Genetic Screening and Testing: Three Case Studies
The rapidly evolving genetic technologies that are available to patients and obstetrician–gynecologists have transformed the practice of clinical medicine. From cell-free DNA screening technologies in pregnancy to expanded carrier screening and hereditary cancer gene panels, obstetrician–gynecologists often are faced with questions about their legal responsibilities regarding genetic information as well as the legal ramifications of this information for their patients. The Committee on Genetics has constructed the following case studies to highlight some of the legal issues an obstetrician–gynecologist may encounter when performing genetic testing. These cases do not cover the breadth of legal issues affecting clinical genetics, but rather they illustrate certain legal concepts and principles as well as key pieces of legislation that are pertinent to clinical care. These case descriptions are not intended to serve as legal advice. Obstetrician–gynecologists are strongly encouraged to seek expert legal assistance to resolve questions involving legal rights or responsibilities.

Practice Bulletin 219: Operative Vaginal Birth (Interim Update)
Despite significant changes in management of labor and delivery over the past few decades, operative vaginal birth remains an important component of modern labor management, accounting for 3.3% of all deliveries in 2013 (1). Use of obstetric forceps or vacuum extractor requires that an obstetrician and obstetric care provider be familiar with the proper use of the instruments and the risks involved. The purpose of this document is to provide a review of the current evidence regarding the benefits and risks of operative vaginal birth.

The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of 60,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org